CMS pushes back CJR expansion, cardiac bundled payment initiatives by 3 months

HHS Secretary Tom Price is no fan of mandatory bundled payments, and not surprisingly, CMS is now delaying multiple bundled payment initiatives.


With the Trump administration in office, it comes as no surprise that the Centers for Medicare and Medicaid Services have delayed a number of bundled payment initiatives.

In an interim rule posted in the Federal Register, CMS delayed the expansion of the Comprehensive Care for Joint Replacement Model as well as the implementation of cardiac bundled payment initiatives from July 1, 2017 to October 1, 2017. Additionally, the rule pushes back the effective date of the Cardiac Rehabilitation Incentive Payment Model from July 1 to October 1.

The interim rule does one other thing: For the second time, it delays the effective date of a final rule that outlines the implementation of CJR and other bundled payment initiatives. In February, the effective date was delayed from February 18 to March 21. Now the effective date has been pushed back from March 21 to May 20.

The interim rule states,

This interim final rule with comment period (IFC) further delays the effective date of the final rule entitled “Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model” published in the January 3, 2017 Federal Register(82 FR 180) from March 21, 2017 until May 20, 2017. This IFC also delays the applicability date of the regulations at 42 CFR part 512 from July 1, 2017 to October 1, 2017 and effective date of the specific CJR regulations itemized in the DATES section from July 1, 2017 to October 1, 2017.

CMS added that it may consider pushing back CJR expansion and the implementation of cardiac bundled payments until next year. “We seek comment on the appropriateness of this delay, as well as a further applicability date delay until January 1, 2018,” the interim rule says. The comment period on the rule is open until April 19.

For avid followers of healthcare policy, the delays are far from shocking. “I’m not surprised at all,” said naviHealth COO Carter Paine in a phone interview. “From a timing perspective, with Secretary Price only holding his seat for a couple weeks and Seema Verma getting confirmed last week, the prudent thing for them is to dig into these issues. I’m not surprised they’re delaying it and going through the implications.”

Tom Price, the newly minted secretary of the Department of Health and Human Services, has expressed his vehement opposition to bundled payment initiatives. In a letter to CMS last fall, he claimed that through such mandatory initiatives, the Center for Medicare and Medicaid Innovation was “experimenting with Americans’ health.”

Though the comment period on the interim final rule remains open for another month, observers have already started to take guesses on what will happen next. “The mandatory side of the bundles is, we think, probably unlikely,” said Paine. “We think the voluntary bundles will continue on, and we’ll see an advanced BCPI program come through in the next few months.” Paine noted that moving forward with the BCPI program and keeping bundled payments voluntary are Republican ideas that are likely to occur with Secretary Price and and CMS Administrator Seema Verma in office.

“I think you’ll continue to see private insurers seek ways to create better value for patients,” Paine added. “It’s a no-brainer when you see some of the results with our providers participating in the BCPI program.”

For right now, the future remains uncertain. But given what we know of the new administration, a push for mandatory bundled payments seems improbable.

Photo: atibodyphoto/ Getty Images

Editor’s note: This article previously included the word “payers” instead of “providers” in Paine’s last quote.